Very few of us live isolated lives that do not involve interacting with other people or the wider
society. These interactions impact on our mental well-being. Good relationships, for example,
appear to be protective against mental health problems. Poor relationships or living in a
stressful environment increase our risk for such problems. This chapter considers two
important social factors that influence mental health: the family and the social environment in
which we live. It then considers how some of these problems may be ameliorated through
family therapy or the use of health promotion and other public health interventions. The
chapter then goes on to consider how cultural factors may influence the presentation and
treatment of a number of mental health problems. By the end of the chapter, you should have
an understanding of:

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Theoretical models of the family and family problems

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Interventions that involve the whole family

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The impact of social and cultural factors such as socio-economic class, gender and
ethnicity on mental health

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How mental health problems may present and be treated across differing cultures

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How health promotion and public health programmes may improve the mental well-being
of individuals and populations.

Family models of mental health disorders

Family models of mental health disorders and their treatment are based on systems
theory. This views the family or other social groups as an interrelated set of individuals. The behaviour of each person within the system does not occur in isolation.
Instead, behaviour follows a principle of circularity in which no one behaviour is seen
as starting or being the outcome of events. The behaviour of X affects Y, whose
behaviour reciprocally affects X, whose response to this affects Y, and so on.
Behaviours form a continuous causal loop, with no beginning or end-point. Change
within this continuous set of behaviours can be achieved by intervening at any point
in the system.

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